OBJECTIVE: To identify characteristics of patients with early, untreated Parkinson's disease that are the most important predictors of rapid functional decline. DESIGN: Prospective observational study of a cohort of 800 patients with early, untreated Parkinson's disease who were involved in a multicenter, randomized, double-blind, controlled clinical trial of selegiline hydrochloride (L-deprenyl) and vitamin E (alpha-tocopherol). PRIMARY OUTCOME VARIABLE: Time from randomization to the onset of disability that necessitated levodopa therapy (end point), as judged by the enrolling investigator. METHODS: Stepwise Cox regression was used in combination with clinical judgment to identify the most important independent baseline predictors of the primary end point among a host of variables, including treatment with selegiline and vitamin E, global and specific clinical measures of disease severity, demographic variables, and neuropsychological test results. RESULTS: In addition to selegiline treatment and global disease severity measures, such as the stage according to the criteria of Hoehn and Yahr, impaired domestic capacity, and the activities of daily living score, the complex of postural instability/gait difficulty and bradykinesia were found to be the factors that were most highly associated with the risk of reaching the end point. CONCLUSIONS: The findings suggest that patients with Parkinson's disease whose early clinical presentation includes either postural instability/gait difficulty or bradykinesia are at high risk for rapid functional decline.
RCT Entities:
OBJECTIVE: To identify characteristics of patients with early, untreated Parkinson's disease that are the most important predictors of rapid functional decline. DESIGN: Prospective observational study of a cohort of 800 patients with early, untreated Parkinson's disease who were involved in a multicenter, randomized, double-blind, controlled clinical trial of selegiline hydrochloride (L-deprenyl) and vitamin E (alpha-tocopherol). PRIMARY OUTCOME VARIABLE: Time from randomization to the onset of disability that necessitated levodopa therapy (end point), as judged by the enrolling investigator. METHODS: Stepwise Cox regression was used in combination with clinical judgment to identify the most important independent baseline predictors of the primary end point among a host of variables, including treatment with selegiline and vitamin E, global and specific clinical measures of disease severity, demographic variables, and neuropsychological test results. RESULTS: In addition to selegiline treatment and global disease severity measures, such as the stage according to the criteria of Hoehn and Yahr, impaired domestic capacity, and the activities of daily living score, the complex of postural instability/gait difficulty and bradykinesia were found to be the factors that were most highly associated with the risk of reaching the end point. CONCLUSIONS: The findings suggest that patients with Parkinson's disease whose early clinical presentation includes either postural instability/gait difficulty or bradykinesia are at high risk for rapid functional decline.
Authors: Shinichi Amano; Joe R Nocera; Srikant Vallabhajosula; Jorge L Juncos; Robert J Gregor; Dwight E Waddell; Steven L Wolf; Chris J Hass Journal: Parkinsonism Relat Disord Date: 2013-07-05 Impact factor: 4.891
Authors: Sotirios A Parashos; Jordan Elm; James T Boyd; Kelvin L Chou; Lin Dai; Zoltan Mari; John C Morgan; Lewis Sudarsky; Catherine L Wielinski Journal: J Parkinsons Dis Date: 2015 Impact factor: 5.568
Authors: Sotirios A Parashos; Sheng Luo; Kevin M Biglan; Ivan Bodis-Wollner; Bo He; Grace S Liang; G Webster Ross; Barbara C Tilley; Lisa M Shulman Journal: JAMA Neurol Date: 2014-06 Impact factor: 18.302
Authors: Ellen N Sutter; Katie J Seidler; Ryan P Duncan; Gammon M Earhart; Marie E McNeely Journal: J Rehabil Med Date: 2017-06-28 Impact factor: 2.912
Authors: Sotirios A Parashos; Christopher J Swearingen; Kevin M Biglan; Ivan Bodis-Wollner; Grace S Liang; G Webster Ross; Barbara C Tilley; Lisa M Shulman Journal: Arch Neurol Date: 2009-07-13
Authors: Serene S Paul; Anne Thackeray; Ryan P Duncan; James T Cavanaugh; Theresa D Ellis; Gammon M Earhart; Matthew P Ford; K Bo Foreman; Leland E Dibble Journal: Arch Phys Med Rehabil Date: 2015-12-01 Impact factor: 3.966
Authors: Jing Zhang; Hayley A Mattison; Changqin Liu; Carmen Ginghina; Peggy Auinger; Michael P McDermott; Tessandra Stewart; Un Jung Kang; Kevin C Cain; Min Shi Journal: Acta Neuropathol Date: 2013-05-04 Impact factor: 17.088